PB2564: COVID-19 AND FERRITIN
Authors: Bohdana Kuiavovych, Nadiia Goryainova, Olga Basova, Valentyna Kubarova
Journal: HemaSphere (2023)

Topic: 29. Iron metabolism, deficiency and overload Background: COVID-19 continues to spread rapidly throughout the world, causing serious concerns because of its effect on many systems and its long-term consequences. SARS-CoV-2 has high infectivity and transmissibility rate, which caused a pandemic. The virus enters human cells using angiotensin-converting enzyme 2, which is expressed in multiple tissues, leading to organ damage due to such mechanisms as direct viral toxicity, endothelial cell damage, inflammation, and dysregulation of the immune response. The mentioned processes can also contribute to the release of ferritin. Ferritin is the iron-storage protein recognized as an indicator of iron status, but it is also a well-known acute-phase protein. Pro-inflammatory cytokines, including IL-6, TNF-α, and IL‐1β, play a significant role in COVID-19 pathogenesis. Besides, they have also been to induce ferritin synthesis. At the same time, ferritin also plays a pathogenic role in the inflammation process by promoting the expression of multiple pro‐inflammatory mediators forming a closed circle. Aims: To determine the association between serum ferritin level and severity of COVID‐19 to improve early recognition of high‐risk patients for prompt management. Methods: This retrospective study included 37 survival patients with COVID-19, confirmed by SARS-CoV-2 RNA detection and level of ferritin greater than the normal range, who consulted a hematologist for this reason. The immunochemiluminescent method was applied to measure serum ferritin levels. The interquartile range (IQR) was used to measure the spread of the middle half of the data. A p-value was used to validate a hypothesis against observed data. Results: The median age of patients was 52 years (IQR 41–68), ranging from 26 to 82 years. Most patients were male (n=23; 62,2%). According to the WHO COVID-19 disease severity categorization, 4 (10,8%) patients with acute respiratory distress syndrome were classified as having critical COVID-19, 19 (51,3%) patients with SpO2 of 90% or lower or respiratory rate > 30 breaths per minute, were classified as having severe COVID-19, whereas 14 (37,8%) patients were considered non-severe. The severe and critical patients were older (median age 68 years compared with 56 years in the non-severe group) and more frequently had comorbidities. The mean value of ferritin at the stage of confirming the diagnosis of COVID-19 in critical cases was 1241 (926-1694) ng/mL, in severe – 727 (427-1043) ng/mL, in non-severe – 534 (307-814) ng/mL. Serum ferritin levels were significantly higher in critical cases compared with severe category patients (p<0,05) and markedly higher in severe in comparison with non-severe patients (p<0,05). Furthermore, ferritin tended to be more elevated in severe patients compared with non-severe category patients throughout the clinical course. Since the ferritin level remains elevated in the post-COVID-19 period in some patients, we are conducting further studies. Summary/Conclusion: Patients with critical and severe COVID-19, compared with non-severe patients, showed significantly higher serum ferritin levels. Elevated ferritin may result from the influence of various stimuli, such as cytokines, hypoxia, growth factors, and cell damage. Therefore, hyperferritinemia at the time of initial diagnosis is associated with a poor prognosis of SARS-CoV-2 infection and could predict the worsening of the disease. Thus, early detection of COVID-19 patients with hyperferritinemia might be beneficial in choosing a treatment plan and decreasing severe complications and mortality. Keywords: Ferritin, COVID-19